Provider Demographics
NPI:1366450900
Name:WEINER, BRUCE HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HENRY
Last Name:WEINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 JOHN RYAN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4113
Mailing Address - Country:US
Mailing Address - Phone:817-292-5140
Mailing Address - Fax:
Practice Address - Street 1:6210 JOHN RYAN DR
Practice Address - Street 2:STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4113
Practice Address - Country:US
Practice Address - Phone:817-292-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry